Phillip Read

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

More women’s stuff- hormonal contraception and HIV risk.

You’re probably aware that 3 studies were published in the last few months linking, particularly injectable contraception, to HIV transmission and susceptibility (Wand et al, Sullivan et al and Heffron et al). Renee Heffron was able to provide more data on her study (partners in prevention HIV/HSV transmission study). Despite cutting the data several ways, including new variables around potential sexual confounders, and performing various sensitivity analyses, the adjusted Hazard ratio for injectable contraception and HIV acquisition was still about 2.0.

The data though, is conflicting. Pollis presented a meta-analysis of the various studies in this field. Many of them were of too poor quality to provide firm data, and the studies were rarely purposefully designed with this endpoint in mind, but were often post-hoc analyses of other studies and unable to adequately control for all possible confounders. Nonetheless, the WHO still recommend particular counselling to young women using injectable contraception that they really do need to use condoms thoroughly to reduce their HIV risk.

Fichorova presented a complicated study trying to unravel the biological mechanism behind these findings. She looked at markers of inflammation or HIV susceptibility in the cervices of 800 women with and without and STI, and taking or not taking various forms of contraception. I got a bit stuck in the immunology and cytokine mire, but essentially she found that DMPA increased RANTES (some sort of marker of inflammation) in all women, and that DMPA also reduced protective mediators in the cervix. Not causal, but an initial attempt to provide biological plausibility to this theory.